Photo of Pope Benedict XVI

Birthday Blessings for Pope Benedict XVI
A gift of public service
from U.S. Catholic youth and students
Pledge Form

* Required Fields.
No personal information solicited as part of this form submission will be sold, traded or used in any way that would violate your trust. Our intention is to use it only if we need to contact you to clarify any part of your submission.

* Name of School / Parish / College / Seminary / Other Organization

Diocese Archdiocese
* (Arch)Diocese Where Service Hours Are Being Pledged

* Total hours completed or pledged by all individuals pledging (for completion by May 31, 2008)
Please do the math acccurately - for example 212 people contributing 20 hours each = 4,240 hours. You would enter 4,240, not 20.

Number of individuals pledging hours (if available)
Please enter the correct number of all individuals that are pledging/completing hours. This is critical to accurate reporting.

* Name of individual completing the form

* Title

  If you selected other enter your title here
  
* Address

Address Line 2

* City

* State (International Countries and/or Dioceses Included Here)


* Zip Code

* Telephone (format: xxx-xxx-xxxx)

* E-mail address

Comments (optional)
Note the kind of community service work. Please mention any unique or distinctive
project that has been undertaken.


* Pledged service hours should be completed by May 31, 2008

 

Please click the Report Button only once to avoid multiple duplicating your report.

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